Effects of a Home-Based DVD-Delivered Physical Activity Program on Self-Esteem in Older Adults: Results From a Randomized Controlled Trial.

OBJECTIVE: Although center-based supervised physical activity interventions have proved to be successful in attenuating health declines in older adults, such methods can be costly and have limited reach. In the present study, we examined the effects of a DVD-delivered exercise intervention on self-esteem and its subdomains and the extent to which these effects were maintained. In addition, we examined whether psychological, demographic, and biological factors acted as determinants of self-esteem. METHODS: Low-active, older adults (n = 307; mean [standard deviation] age =71.0 [5.1] years) were randomly assigned to a 6-month, home-based exercise program consisting of a DVD-delivered exercise intervention focused on increasing flexibility, toning, and balance (FlexToBa) or an attentional control DVD condition focused on healthy aging. Physical self-worth and three subdomains of self-esteem, global self-esteem, and self-efficacy were assessed at baseline, 6 months, and 12 months. RESULTS: There was a differential effect of time for the two groups for physical self-worth (F interaction(2,530.10) = 4.17, p = .016) and perception of physical condition (F interaction(1,630.77) = 8.31, p = .004). Self-efficacy, sex, body mass index, and age were significant predictors of changes in physical self-worth and perception of physical condition. CONCLUSION: Our findings suggest that a DVD-delivered exercise intervention is efficacious for improving and maintaining subdomain and domain levels of self-esteem in older adults. In addition, self-efficacy was the strongest predictor of changes in physical self-worth and perceptions of physical condition. This innovative method of delivering an exercise training program via DVD is practical and effective and has the potential for broad reach and dissemination. TRIAL REGISTRATION: Clinicaltrials.govidentifier:NCT01030419.

Relationship between fruit and vegetable intake and interference control in breast cancer survivors.

PURPOSE: Nutrition plays an important role in brain structure and function, and the effects of diet may even be greater in those at greater risk of cognitive decline, such as individuals with cancer-related cognitive impairment. However, the relation of dietary components to cognitive function in cancer survivors is unknown. The objective of this study was to determine whether breast cancer survivors (BCS) evidenced impairments in interference control, a component of cognitive control, compared to age-matched women with no prior history of cancer, and to examine the moderating role of diet on cognitive function. METHODS: In this cross-sectional study, a modified flanker task was used to assess interference control in BCS (n = 31) and age-matched women with no prior history of cancer (n = 30). Diet was assessed with 3-day food records. Differences between BCS and age-matched controls were assessed using linear mixed models, and multilevel regression analyses were conducted to assess the moderating role of diet on cognitive performance. RESULTS: Cognitive performance was not different between groups. Fruit intake and vegetable intake were significantly associated with better performance on the incompatible condition of the flanker task (i.e., shorter reaction time and increased accuracy), independent of disease status. The association between dietary components and cognition was stronger for the incompatible incongruent condition, suggesting that fruit and vegetables may be important for the up-regulation of cognitive control when faced with higher cognitive demands. CONCLUSIONS: There was no difference in performance on an interference control task between BCS and age-matched controls. The data suggest that greater fruit intake and vegetable intake were positively associated with interference control in both BCS and age-matched controls.

Subjective memory impairment and well-being in community-dwelling older adults.

BACKGROUND: The relationship between subjective memory impairment (SMI), future cognitive decline, and negative health status provides an opportunity for interventions to reduce memory complaints in high-risk groups. This study aimed to examine the relationship between SMI and indicators of well-being in older adults enrolled in an exercise trial. Additionally, the study examined whether two different modes of exercise training, aerobic walking and non-aerobic flexibility, toning, and balance, differentially influenced subjective memory across the trial. METHODS: Community-dwelling older adults (n = 179, mean age = 66.4 years) were randomly assigned to a walking or flexibility, toning, and balance group for 12 months. Subjective memory, happiness, perceived stress, and symptom reporting were measured at baseline, 6 months, and 12 months. RESULTS: A main effect of subjective memory indicated that individuals with the fewest memory complaints had lower perceived stress (P < 0.001), lower physical symptom reporting (P < 0.001), and higher happiness levels (P < 0.001) across all measurement occasions. Both main and interaction effects of time and group on SMI were not significant, suggesting SMI remained stable across the intervention and was not significantly impacted by participation in exercise training. CONCLUSIONS: SMI was not responsive to exercise interventions, and the relationship between SMI and negative well-being demonstrates a need for interventions to reduce memory complaints in high-risk groups.

Prevalence and correlates of depression, posttraumatic stress disorder, and suicidality in Jordanian youth in institutional care.

Youth in institutional care centers have higher mental illness rates compared with community populations. Research examining mental illness among youth in institutional care in the Middle East is lacking. This study examines the prevalence and correlates of depression, posttraumatic stress disorder (PTSD), and suicidality of youth in institutional care in Jordan. Data were collected through youth interviews, staff-caregiver surveys, and administrative files. Prevalence rates and logistic regressions were used to model suicidality across depression, PTSD, and comorbid depression/PTSD, controlling for youth characteristics, case history, and social support factors. Institutionalized youth endorsed high rates of mental illness (45% depression, 24% PTSD, 17% depression/PTSD, 27% suicidality). The odds of suicidality for depressed youth were 3.6 times higher. Abuse was significant, with the odds of suicidality for abused youth 4 times higher. Elevated rates of mental illness and suicidality indicate the importance of addressing these needs within institutions. Developing institutional programs that foster peer relationships is recommended.

Physical activity levels and patterns in older adults: the influence of a DVD-based exercise program.

The use of multimedia to influence health behaviors offers unique advantages over more traditional center-based programs, however, little is known about the effectiveness of such approaches in improving physical activity levels over time. The purpose of this study was to examine the efficacy of a progressive and age-appropriate, DVD-delivered exercise program in promoting physical activity levels among older adult cohorts. Community dwelling older adults (N = 307, Mean age = 71 years) were randomized to one of two groups: a 6-month home-based DVD-delivered exercise (i.e., FlexToBa™) intervention group or a healthy aging DVD control group. Physical activity was assessed objectively using a standard 7-day accelerometer wear period and subjectively using the Godin Leisure Time Exercise Questionnaire, at baseline and follow-up. Analysis of covariances indicated a statistically significant treatment effect for subjectively [F(1,250) = 8.42, P = .004, η(2) = .03] and objectively [F(1,240) = 3.77, P = .05, η(2) = .02] measured physical activity. The older cohort (>70) in the FlexToBa condition further had significantly larger improvements in physical activity levels compared to their younger counterparts. From a public health perspective, media-delivered interventions such as the FlexToBa program might prove to be cost-effective, have a broader reach and at the same time be effective in improving physical activity levels in older adults.

Stigma and mental health treatment of adolescents with depression in jordan.

Stigma is a fundamental barrier to seeking and engaging in mental health treatment for individuals managing depression. This study examines stigma perceptions of mental health treatment for Arab adolescents managing depression using a vignette survey completed by adults in public spaces in Amman, Jordan (n = 108). The vignette was systematically changed across four different conditions that varied the described youth's gender and whether or not they were receiving treatment for their depression. Two-way ANOVAs found that gender and receipt of mental health treatment influenced perceptions of stigma. Seeking treatment, however, did not increase perceived stigma, and receiving mental health treatment rather than no treatment was found as more likely to be a helpful approach for both males and females. Findings indicate that personal level stigma may have greater effects on females whereas public stigma may exert more influence on males. Participants endorsed that adolescents with depression are most likely to be helped when a family sought treatment rather than not seeking treatment. Findings also indicate that the community seems to appreciate the need for treatment and the likelihood of benefiting from formal mental health services.

Spanking and children's externalizing behavior across the first decade of life: evidence for transactional processes.

Despite a growing literature associating physical discipline with later child aggression, spanking remains a typical experience for American children. The directionality of the associations between aggression and spanking and their continuity over time has received less attention. This study examined the transactional associations between spanking and externalizing behavior across the first decade of life, examining not only how spanking relates to externalizing behavior leading up to the important transition to adolescence, but whether higher levels of externalizing lead to more spanking over time as well. We use data from the Fragile families and child well-being (FFCW) study to examine maternal spanking and children's behavior at ages 1, 3, 5, and 9 (N = 1,874; 48% girls). The FFCW is a longitudinal birth cohort study of children born between 1998 and 2000 in 20 medium to large US cities. A little over a quarter of this sample was spanked at age 1, and about half at age 3, 5, and 9. Estimates from a cross-lagged path model provided evidence of developmental continuity in both spanking and externalizing behavior, but results also highlighted important reciprocal processes taking hold early, with spanking influencing later externalizing behavior, which, in turn, predicted subsequent spanking. These bidirectional effects held across race/ethnicity and child's gender. The findings highlight the lasting effects of early spanking, both in influencing early child's behavior, and in affecting subsequent child's externalizing and parental spanking in a reciprocal manner. These amplifying transactional processes underscore the importance of early intervention before patterns may cascade across domains in the transition to adolescence.

Assessment of adolescent mental health and behavioral problems in institutional care: discrepancies between staff-reported CBCL scores and adolescent-reported YSR scores.

For children residing in institutional settings, staff act as primary caregivers and often provide assessment of child psychopathology. Minimal research exists on how and when staff-caregivers are best positioned to report on youth mental health. This study examines differences between 60 staff-reported and 60 adolescent-reported Child Behavioral Checklist/Youth Self-Report (CBCL/YSR) scores in Jordanian care centers, and the associations between adolescent-staff agreement, demographic characteristics and child-caregiver relationship factors. Results indicated small to modest correlations between informant scores. Additionally, staff-caregivers who know the child over 1 year and have a high perceived fit are better able to approximate the adolescent's self-report of psychopathology.

Associations between attention, affect and cardiac activity in a single yoga session for female cancer survivors: an enactive neurophenomenology-based approach.

Yoga practice is reported to lead to improvements in quality of life, psychological functioning, and symptom indices in cancer survivors. Importantly, meditative states experienced within yoga practice are correlated to neurophysiological systems that moderate both focus of attention and affective valence. The current study used a mixed methods approach based in neurophenomenology to investigate associations between attention, affect, and cardiac activity during a single yoga session for female cancer survivors. Yoga practice was associated with a linear increase in associative attention and positive affective valence, while shifts in cardiac activity were related to the intensity of each yoga sequence. Changes in attention and affect were predicted by concurrently assessed cardiac activity. Awareness of breathing, physical movement, and increased relaxation were reported by participants as potential mechanisms for yoga's salutary effects. While yoga practice shares commonalities with exercise and relaxation training, yoga may serve primarily as a promising meditative attention-affect regulation training methodology.

Child mental health in Jordanian orphanages: effect of placement change on behavior and caregiving.

BACKGROUND: To assess the mental health and behavioral problems of children in institutional placements in Jordan to inform understanding of current needs, and to explore the effects of placement change on functioning and staff perceptions of goodness-of-fit. METHODS: An assessment was completed of 134 children between 1.5-12 years-of-age residing in Jordanian orphanages. The Child Behavior Checklist was used to assess prevalence rates of problems across externalizing and internalizing behavior and DSM-IV oriented subscales. Also included was caregiver perceived goodness-of-fit with each child, caregiving behavior, and two placement change-clock variables; an adjustment clock measuring time since last move, and an anticipation clock measuring time to next move. RESULTS: 28% were in the clinical range for the internalizing domain on the CBCL, and 22% for the externalizing domain. The children also exhibited high levels of clinical range social problems, affective disorder, pervasive developmental disorder, and conduct problems. Internalizing problems were found to decrease with time in placement as children adjust to a prior move, whereas externalizing problems increased as the time to their next age-triggered move drew closer, highlighting the anticipatory effects of change. Both behavioral problems and the change clocks were predictive of staff perceptions of goodness-of-fit with the children under their care. CONCLUSIONS: These findings add to the evidence demonstrating the negative effects of orphanage rearing, and highlight the importance of the association between behavioral problems and child-caregiver relationship pathways including the timing of placement disruptions and staff perceptions of goodness-of-fit.

Stigma and adolescents with psychosis in the Middle East: implications for engaging in mental health treatment.

Stigma is a fundamental barrier to individuals seeking out mental health treatment in the Middle East. The impact of stigma may be amplified if the engagement in and utilization of mental health services for psychosis further stigmatizes individuals and their families. One hundred four Jordanians (N = 104) participated in an experimental vignette survey examining stigma perceptions and social exclusion related to adolescents with psychosis, with the vignettes varying in sex of the youth and whether their family had sought mental health services. The results found that seeking treatment did not add to perceived stigma, and both the male and female adolescents receiving mental health treatment were viewed as significantly more likely to be helped than those not in treatment (p < 0.001). Therefore, receiving mental health treatment did not further stigmatize these Arab youth with psychosis. In addition, seeking out and engaging adolescents and their family in mental health treatment were positively perceived and may help to improve the youth's prognosis and outcomes.

A Relational Workforce Capacity Approach to Trauma-Informed Care Implementation: Staff Rejection Sensitivity as a Potential Barrier to Organizational Attachment.

This study explores the relationship between staff rejection sensitivity (a psychological concept grounded in histories of loss and trauma) and organizational attachment among mental health agencies transitioning to Trauma-Informed Care (TIC), which is currently outside the focus of most research. Specifically, this study examines: (1) whether staff rejection sensitivity predicts organizational attachment; (2) whether staff turnover intentions account for the association between rejection sensitivity and organizational attachment; and (3) whether those associations hold once taking into account staff demographic factors (gender, race and ethnicity, education, and income)? Around 180 frontline workers in three Northeastern U.S. mental health agencies responded to surveys collected between 2016 and 2019 using the organizational attachment, rejection sensitivity and turnover intention measures, and their previous TIC training experience. Rejection sensitivity was significantly associated with organizational attachment (ß = -0.39, p < 0.001), accounting for 6% of its variance in organizational attachment. The relationship between these variables retained significance, and staff education significantly predicted organizational attachment, with higher education predicting lower levels of organizational attachment (ß = -0.15, p < 0.05), accounting for 22% of its variance. This study concludes that TIC transitioning mental health agencies' staff with a higher rejection sensitivity are more likely to express lower organizational attachment and higher intent-to-turnover.

Expanding the Trauma-Informed Care Measurement Toolkit: An Evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC-45) Scale with SUD Workers in PIMH.

Human service organizations (HSO) have increasingly recognized the value of employing trauma-informed care (TIC) in a variety of practice settings. Evidence suggests that effectively adopting TIC has shown client improvements. Organizational barriers to TIC implementation, however, exist. To improve TIC practice, the attitudes related to trauma-informed care (ARTIC) scale was developed to measure staff attitudes and beliefs towards TIC. The ARTIC has been widely adopted by researchers without evaluating its psychometric performance in diverse practice settings. The purpose of this study was to independently validate the ARTIC scale drawn from a sample of staff (n = 373) who provide services to substance-using parents. Psychometric tests were conducted to evaluate how the ARTIC performs with our HSO population. Results from a confirmatory factor analysis showed poor fit (X2 = 2761.62, df = 2.96; RMSEA = 0.07 [0.07, 0.08]; CFI = 0.72). An exploratory factor analysis was conducted to analyze how the data fit with our specific population, yielding 10 factors. Finally, a qualitative inter-item analysis of these factors was conducted, resulting in nine factors. Our findings suggest that measuring TIC attitudes and beliefs may vary according to field of practice and ethno-racially diverse workers. Further refinement of the ARTIC may be necessary for various services domains.

Yoga & cancer interventions: a review of the clinical significance of patient reported outcomes for cancer survivors.

Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors. A total of 25 published yoga intervention studies for cancer survivors from 2004-2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings. Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies.

Corporal punishment and child behavioral and cognitive outcomes through 5 years-of-age: Evidence from a contemporary urban birth cohort study.

This study examined the prevalence and determinants of spanking of children at 3 years-of-age, and the associations between spanking and externalizing behavior and receptive verbal ability at age 5. Overall, we find maternal spanking rates of 55.2% and paternal rates of 43.2% at age 3. Mothers facing greater stress and those who spanked earlier are more likely to spank at age 3, whereas those who report a supportive partner during pregnancy and those who were not U.S. born were less likely to spank. Mothers and fathers in communities where spanking was more normative were more likely to spank. Fathers were less likely to spank daughters at age 3. Frequent maternal spanking at age 3 was associated with externalizing behavior and receptive vocabulary at age 5, controlling for an array of ecological risks, earlier behavior, and verbal capacity. Taking advantage of the large and diverse sample we explored potential interactions and found no evidence that race, parental warmth, normativeness, or child gender moderated the association between spanking and externalizing or receptive vocabulary. These findings add to the literature on negative consequences associated with a widely endorsed parenting practice, and highlight the need for research that explores alternative effective discipline practices and addresses parent questions of what else they could, or even should, be doing.

Who Spanks Infants and Toddlers? Evidence from the Fragile Families and Child Well-Being Study.

We use data from the Fragile Families and Child Well-Being Study (FFCW), a birth cohort study of children in 18 medium to large U.S. cities, to examine the prevalence and determinants of spanking among infants and toddlers (at mean age 14 months). Taking advantage of the large and diverse sample in FFCW, we conduct separate analyses for children of African American (N=1,710), Hispanic (N=853), and white non-Hispanic (N=812) mothers. Overall, about 15% of children are spanked at 12 months, with this share rising to 40% by 18 months and nearly 50% for children age 20 months or older. We find that there are marked differences in the use of spanking across the three racial/ethnic groups, with children of African American mothers more likely to be spanked and at a younger age. Moreover, while some predictors of spanking are seen across all three groups, others vary. Mothers who are young, who report more parental stress, or report their child has a more difficult temperament are more likely to spank across all three groups. However, being a boy increases the risk of spanking only within African American families. First-born children are at elevated risk of spanking to at least some extent in all groups, but much more so within Hispanic families. In addition, maternal employment is associated with a greater likelihood of spanking in Hispanic families.Although spanking at these young ages is not necessarily indicative of maltreatment, it may be a marker for families who are at elevated risk of maltreatment. As such, our findings, by highlighting some risk factors that are common across groups as well as some that are more important for particular groups, may have implications for child abuse prevention.

Toward a cumulative ecological risk model for the etiology of child maltreatment.

The purpose of the current study was to further the integration of cumulative risk models with empirical research on the etiology of child maltreatment. Despite the well-established literature supporting the importance of the accumulation of ecological risk, this perspective has had difficulty infiltrating empirical maltreatment research and its tendency to focus on more limited risk factors. Utilizing a sample of 842 mother-infant dyads, we compared the capacity of individual risk factors and a cumulative index to predict maltreatment reports in a prospective longitudinal investigation over the first sixteen years of life. The total load of risk in early infancy was found to be related to maternal cognitions surrounding her new role, measures of social support and well-being, and indicators of child cognitive functioning. After controlling for total level of cumulative risk, most single factors failed to predict later maltreatment reports and no single variable provided odd-ratios as powerful as the predictive power of a cumulative index. Continuing the shift away from simplistic causal models toward an appreciation for the cumulative nature of risk would be an important step forward in the way we conceptualize intervention and support programs, concentrating them squarely on alleviating the substantial risk facing so many of society's families.

Implementation Fidelity in the Replication of Tuning in to Teens (TINT) Adapted for Adoptive Parents and Guardians in the US.

Purpose: Clear explication of the conditions necessary to reproduce results is imperative in the development of evidence-based interventions.Methods: This study used a fidelity framework to guide the exploration of implementation fidelity in a study of the Tuning in to Teens (TINT) intervention in New Jersey. TINT is an evidence-based prevention program - previously tested with parents of pre-adolescents to reduce emotionally dismissive parenting - that was adapted for use with adoptive and guardianship families.Results: The review of intervention design adaptation and protocols; intervention training; and monitoring of intervention delivery revealed extensive efforts by an adoption clinician, the purveyor of the program, and an implementation team to support the implementation efforts. Results of the monitoring of intervention receipt indicate that the intervention was implemented with high fidelity.Discussion: Future intervention research should consider assessing the effects of implementation efforts on outcomes to improve replication under real-world conditions. Regardless, this exploration of fidelity has implications for public and private organizations seeking to implement an evidence-based intervention. The framework developed by Gearing and Colleagues and the TIDieR checklist could provide useful guidance when planning for and reporting on implementation fidelity in the furtherance of developing and disseminating evidence-based interventions.

Frontline Staff Characteristics and Capacity for Trauma-Informed Care: Implications for the Child Welfare Workforce.

BACKGROUND: Improved understanding of the lasting ways trauma can impact self-regulatory and relational capacities have increased calls for Trauma-Informed Care (TIC) for child welfare-involved families. Little is known, however, about how the attitudes and characteristics of frontline workers impact the implementation of TIC and job retention. This work fills an important gap in knowledge regarding the relationship between staff relational capacities, the implementation of TIC and staff retention. OBJECTIVE: To understand the relationship between staff characteristics, endorsement of TIC and intent to turnover. PARTICIPANTS AND SETTING: Three child and family serving agencies surveyed 271 staff from a populous Northeastern state. METHODS: Regression analyses were used to examine the relationship between staff characteristics, Attitudes Related to Trauma Informed Care (ARTIC) score, and intent to turnover. RESULTS: Higher levels of staff rejection sensitivity was associated with lower endorsement of Principles of Trauma-Informed Care (p < .05). Lower staff alignment with principles of TIC was associated with higher levels of intention to turnover and leave their organization (p < .05). CONCLUSION: Staff histories of relational loss and trauma may impact both workforce buy-in and readiness to implement TIC. Therefore, identifying staff sensitivity to rejection in the hiring process or after hire, and providing specific supports, such as reflective supervision, may enhance both service delivery and staff experiences' of their work. Additionally, using the ARTIC scale in the hiring process may also reduce staff turnover and burnout. Attending to staff relational characteristics is a critical component of promoting worker resilience.